Director - Utilization Review

Company: Memorial Healthcare System
Location: Miramar
Posted on: October 20, 2024

Job Description:

Location:Miramar, FloridaAt Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience.Summary:Directs the department's activities and resources to ensure alignment with the mission, values, and objectives of the department and organization.Responsibilities:Prepares and evaluates departmental budgets, and ensures that the department operates in compliance with allocated funding. Coordinates and directs internal/external audits.Plans and monitors staffing activities, including hiring, orienting, evaluating, disciplinary actions, and continuing education initiatives.Manages and evaluates department operations, including information technologies, service level determination and complaint management, to achieve performance and quality control objectives.Develops and implements departmental goals, plans, and standards consistent with the clinical, administrative, legal and ethical requirements of the organization.Works collaboratively with other disciplines, physician liaison, and facility Directors of Clinical Effectiveness to ensure that utilization review is performed timely, accurately and in compliance with appropriate regulatory bodies.Competencies:ACCOUNTABILITY, ANALYSIS AND DECISION MAKING, CUSTOMER SERVICE, EFFECTIVE COMMUNICATION, MANAGING BUDGETS - MANAGEMENT, MANAGING PEOPLE, RESPONDING TO CHANGE, STANDARDS OF BEHAVIOREducation and Certification Requirements:Accredited Program: Nursing (Required)Registered Nurse License (RN LICENSE) - State of Florida (FL)Additional Job Information:Complexity of Work: Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action. Excellent interpersonal skills needed.Required Work Experience: 5 years leadership experience and 2 years experience in utilization case management.Working Conditions and Physical Requirements:

• -Bending and Stooping = 60%
• -Climbing = 0%
• -Keyboard Entry = 80%
• -Kneeling = 40%
• -Lifting/Carrying Patients 35 Pounds or Greater = 0%
• -Lifting or Carrying 0 - 25 lbs Non-Patient = 60%
• -Lifting or Carrying 2501 lbs - 75 lbs Non-Patient = 0%
• -Lifting or Carrying > 75 lbs Non-Patient = 0%
• -Pushing or Pulling 0 - 25 lbs Non-Patient = 60%
• -Pushing or Pulling 26 - 75 lbs Non-Patient = 0%
• -Pushing or Pulling > 75 lbs Non-Patient = 0%
• -Reaching = 60%
• -Repetitive Movement Foot/Leg = 0%
• -Repetitive Movement Hand/Arm = 80%
• -Running = 0%
• -Sitting = 80%
• -Squatting = 40%
• -Standing = 80%
• -Walking = 80%
• -Audible Speech = 80%
• -Hearing Acuity = 80%
• -Smelling Acuity = 0%
• -Taste Discrimination = 0%
• -Depth Perception = 80%
• -Distinguish Color = 80%
• -Seeing - Far = 80%
• -Seeing - Near = 80%
• -Bio hazardous Waste = 0%
• -Biological Hazards - Respiratory = 0%
• -Biological Hazards - Skin or Ingestion = 0%
• -Blood and/or Bodily Fluids = 0%
• -Communicable Diseases and/or Pathogens = 0%
• -Asbestos = 0%
• -Cytotoxic Chemicals = 0%
• -Dust = 0%
• -Gas/Vapors/Fumes = 0%
• -Hazardous Chemicals = 0%
• -Hazardous Medication = 0%
• -Latex = 0%
• -Computer Monitor = 80%
• -Domestic Animals = 0%
• -Extreme Heat/Cold = 0%
• -Fire Risk = 0%
• -Hazardous Noise = 0%
• -Heating Devices = 0%
• -Hypoxia = 0%
• -Laser/High Intensity Lights = 0%
• -Magnetic Fields = 0%
• -Moving Mechanical Parts = 0%
• -Needles/Sharp Objects = 0%
• -Potential Electric Shock = 0%
• -Potential for Physical Assault = 0%
• -Radiation = 0%
• -Sudden Decompression During Flights = 0%
• -Unprotected Heights = 0%
• -Wet or Slippery Surfaces = 0%Shift:Primarily for office workers - not eligible for shift differentialDisclaimer: This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification.Wages shown on independent job boards reflect market averages, not specific to any employer. We encourage candidates to talk to their Memorial Healthcare System recruiter to discuss actual pay rates, during the hiring process.Memorial Healthcare System is proud to be an equal opportunity employer committed to workplace diversity.Memorial Healthcare System recruits, hires and promotes qualified candidates for employment opportunities without regard to race, color, age, religion, gender, gender identity or expression, sexual orientation, national origin, veteran status, disability, genetic information, or any factor prohibited by law.We are proud to offer Veteran's Preference to former military, reservists and military spouses (including widows and widowers). You must indicate your status on your application to take advantage of this program.Employment is subject to post offer, pre-placement assessment, including drug testing.If you need reasonable accommodation during the application process, please call 954-276-8340 (M-F, 8am-5pm) or email TalentAcquisitionCenter@mhs.net

Keywords: Memorial Healthcare System, Hialeah , Director - Utilization Review, Executive , Miramar, Florida